MRSA wound infection following Total joint arthroplasty is catastrophic with disastrous consequences. Our aim was to determine the prevalence and risk factors for MRSA colonization in patients presenting for orthopaedic surgery in our unit. All patients admitted to the hospital for elective arthroplasty over a four year period were included in the study. At the time of admission, a detailed questionnaire was completed by each patient. Routine nasal, throat, axilla, perineum swabs and from any pre-existing wound sites were sent for culture.

Among 2900 patients studied, 42 patients (1.4%) were positive for MRSA on admission. The prevalence of MRSA colonization in patients who were admitted directly from Nursing homes or from own home was 36.7% and 1.3% respectively. All MRSA positive patients who were admitted directly from home had at least one documented hospital admission in the preceding year and/or antibiotic administration within three months prior to admission. The risk factors identified for MRSA colonization were in risk order : Nursing home residency(p< 0.05), previous hospital admission(p< 0.05), antibiotic administration in previous three months(p< 0.05), and female gender(p< 0.01 )Statistical analysis with Chi squared test for independence p< 0.05 considered significant.

Present MRSA screening focuses on all patients being admitted for surgery, this contrasts to North American policies of screening only patients with risk factors. We would question the validity and economical reasoning of general rather than targeted screening procedures.